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PubMed1997

Computerized brain atlas in functional neurosurgery.

Computerized brain atlas is a new application area in the practical use of stereotactic neurosurgery. Our approach provides a solution for the straightforward definition of a coordinate system (CA-CP), localization of the selected target point, trepanation points and trajectory transformation of the stereotactic electrode or canula for functional neurosurgery. These problems were solved by comparison of CT, MR and the Schaltenbrand-Wahren atlas. Our original software package integrates all modalities into one system.

Brain↗

PubMed1975

Survey of stereotactic and functional neurosurgery in the United States and Canada.

A survey of the number of neurosurgeons performing stereotactic and functional neurosurgery in the United States and Canada was conducted by questionnaire. Of the 637 respondents, 433 conducted either stereotactic or functional neurosurgery or both. The indications and number of stereotactic procedures done annually are presented. The number of neurosurgeons performing each of the various procedures is outlined, as well as the types of stereotactic apparatus and lesion employed.

Canada↗

PubMed1978

Market power and resource misallocation in medicine: the case of neurosurgery.

This article concludes that substantial excess neurosurgical capacity exists. Neurosurgery like other specialties has permitted almost free entry and as a result of such factors as high earnings and status, excess capacity has developed and because of insufficient competition it has not been eliminated. The costs of excess capacity include idle capacity and an alleged reduction in skill levels. The neurosurgery market's performance is evaluated and it is found that while relative income has declined, entry has continued at a high rate; excess capacity is therefore not being eliminated. Policy recommendations of a pro-competitive variety are suggested to improve the market's performance instead of regulation (whether governmental or by the profession itself).

Economics, Medical↗

PubMedDate not supplied

An analysis (time study) of service and education in a neurosurgery residency program.

A time study analysis of the activities of neurosurgery residents, allocating their time to one of four categories (service, education, questionable, personal), indicates that the service-education percentage ratio is 44.65:37.34 during the week and 61.50:28.11 for the weekend. The distribution of activities within service and education categories identifies the extent to which a neurosurgery resident in this program is a student, although most of the "service" activities are those that a neurosurgeon must learn to perform efficiently in order to practice his specialty.

Education, Medical, Graduate↗

PubMed1995

Neurosurgery at the University of Michigan.

Neurosurgery at the University of Michigan was established as a specialty three-quarters of a century ago by Max Minor Peet. It developed under the successive leadership of Edgar Allan Kahn, Richard Coy Schneider, and Julian T. Hoff. Each has made unique contributions to the program, which has a strong tradition of teaching, research, and patient care. This article traces the development of the training program in neurosurgery at Michigan, focusing on its historical background, past accomplishments, present structure, and future directions.

Curriculum↗

PubMed1995

Neurosurgery at the University of Florida.

The significant factors in the development of the neurosurgery program at the University of Florida have been the funding for 10 endowed chairs and a Brain Institute, the achievement of departmental status in the College of Medicine, the collaborative research with a strong Department of Neuroscience, and the strong commitment by the faculty to subspecialty neurosurgery and to service in the national neurosurgical organizations.

Curriculum↗

PubMed2003

Endovascular restorative neurosurgery: a novel concept for molecular and cellular therapy of the nervous system.

The amalgam of molecular biology and neurosurgery offers immense promise for neurorestoration and the management of neurodegenerative deficiencies, developmental disorders, neoplasms, stroke, and trauma. This article summarizes present strategies for and impediments to gene therapy and stem cell therapy of the central nervous system and advances the concept of a potential new approach, namely endovascular restorative neurosurgery. The objectives of gene transfer to the central nervous system are efficient transfection of host cells, selective sustained expression of the transgene, and lack of toxicity or immune excitation. The requisite elements of this process are the identification of candidate diseases, the construction of vehicles for gene transfer, regulated expression, and physical delivery. In the selection of target disorders, the underlying genetic events to be overcome, as well as their spatial and temporal distributions, must be considered. These factors determine the requirements for the physical dispersal of the transgene, the duration of transgene expression, and the quantity of transgene product needed to abrogate the disease phenotype. Vehicles for conveying the transgene to the central nervous system include viral vectors (retroviruses, lentiviruses, adenoviruses, adeno-associated viruses, and herpes simplex virus), liposomes, and genetically engineered cells, including neural stem cells. Delivery of the transgene into the brain presents several challenges, including limited and potentially risky access through the cranium, sensitivity to volumetric changes, restricted diffusion, and the blood-brain barrier. Genetic or cellular therapeutic agents may be injected directly into the brain parenchyma (via stereotaxy or craniotomy), into the cerebrospinal fluid (in the ventricles or cisterns), or into the bloodstream (intravenously or intra-arterially). The advantages of the endovascular route include the potential for widespread distribution, the ability to deliver large volumes, limited perturbation of neural tissue, and the feasibility of repeated administration.

Animals↗

PubMed2003

Neurosurgery at the University Hospital of North Norway: the history of the northernmost neurosurgical department in the world.

The university hospital of North Norway hosts the northernmost neurosurgical department in the world. The hospital is located in the city of Tromsø, often dubbed "the Gateway to the Arctic." We describe the role of this city in polar exploration, the history preceding the establishment of the world's northernmost university, the history of neurosurgery at this institution, and the present state of the Department of Neurosurgery. The experience from Tromsø shows that it is possible to establish a complete neurosurgical service at remote locations. Training of physicians native to the region, close integration between clinical activities and research, and a wide definition of the specialty has been essential for the success of the department.

History, 19th Century↗

PubMed2005

Neurosurgery at Tribhuvan University Teaching Hospital, Nepal.

February 6, 2005, marks the 10th anniversary of the first neurosurgical procedure performed at Tribhuvan University Teaching Hospital, one of only a few tertiary-care hospitals in Nepal. Neurosurgery began at the hospital with the arrival of an American neurosurgeon to train Nepalese surgeons locally and, later, the return of these Nepalese surgeons to Kathmandu after subsequent fellowship training in the United States. This article traces the origins of neurosurgery in Nepal, outlines the specialty's development in Kathmandu at Tribhuvan University Teaching Hospital during the past decade from international education strategies, and describes the status of and challenges facing the provision of neurosurgical care in Nepal. The role of neurosurgical services in improving the health care status of populations in developing countries is considered. Neurosurgeons in developing and developed countries alike should continue to work to remedy the inequitable distribution of neurosurgical knowledge and services throughout the world.

Developing Countries↗

PubMed2006

Challenges in contemporary academic neurosurgery.

Traditionally, the ideal academic neurosurgeon has been a "quadruple threat," with excellence in clinical work, teaching, research, and administration. This tradition was best exemplified in Harvey Cushing, who developed the field of neurosurgery 90 years ago. This paradigm will probably have to change as academic neurosurgeons face major challenges. In patient care, these include increasing regulatory control, increasing malpractice costs, consolidation of expensive care in academic centers, and decreasing reimbursement; in resident teaching, work hour limitations and a changing resident culture; in research, the increasing dominance of basic scientists in governmental funding decisions and decreased involvement of neurosurgeons in scientific review committees; and in administration, problems of relationships in the workplace, patient safety, and employment compliance in an increasingly bureaucratic system. To meet these challenges, the new academic neurosurgeon will probably not be a quadruple threat personally but will be part of a quadruple threat in a department and institution. Neurosurgeons in such a setting will have to work with hospital, medical school, and national and international groups to address malpractice, reimbursement, subspecialization, and training problems; find supplemental sources of income through grants, development funds, and hospital support; lead in the development of multidisciplinary centers for neuroscience, brain tumor, spine, and other initiatives; and focus on training leaders for hospital, regional, and national groups to reconfigure neurosurgery. Collaboration, flexibility, and leadership will be characteristic of the academic neurosurgeon in this new era.

Academic Medical Centers↗

PubMed2006

Training residents in endovascular neurosurgery.

Neurosurgeons have a long history of treating cerebrovascular disease. Understanding the vascular anatomy and physiology of the nervous system and management of patients with abnormalities of theses vascular structures are vitally important aspects of neurosurgery resident training. Over the past decade, the treatment of cerebrovascular disease has been evolving toward endovascular strategies for many patients. Interventional neuroradiologists were the pioneers in developing this area of therapy, but the number of neurosurgical trainees in neuroendovascular treatment is increasing, and other specialties, including neurology, vascular surgery, and cardiology, are now entering the field of neuroendovascular treatment. The purpose of this article is to review the current credentialing guidelines for neurosurgeons to use endovascular techniques in the treatment of cerebrovascular disease and to consider options for resident training in the rapidly evolving field of endovascular neurosurgery.

Credentialing↗

PubMed1980

The evolving role of the nurse practitioner in neurosurgery.

The authors examine the many important roles for the nurse practitioner in neurosurgery, including patient care in academic departments and private practice, and research and scholarship. The responsibilities of nurse practitioners in a hospital can be varied: they may take some responsibility for all patients on the neurosurgery service, or their assignment may be more specific, such as to the intensive care unit; or they may be assigned to all patients with a specified neurosurgical disorder, such as head injury of intractable pain. Nurse practitioners can become coordinators of clinical research programs, with responsibility for collecting and collating the data and assisting in data analysis and manuscript preparation. Detailed clinical protocols must be developed for nurse practitioners, and those protocols then become the basis for their employment and legal status. Licensure requirements vary greatly among states, and are continuing to change.

Humans↗

PubMed1985

Wide variation in risk of wound infection following clean neurosurgery. Implications for perioperative antibiotic prophylaxis.

The authors have prospectively examined the occurrence of postoperative wound infection following clean neurosurgery in 936 patients. Fewer than 1% received perioperative antibiotic prophylaxis. The overall rate of deep wound infection was 2.6%; no deaths were directly attributable to these infections. Deep wound infections occurred significantly more frequently following craniotomy (4.3%) than following spinal (0.9%) or other clean neurosurgery. Among craniotomies, the deep wound infection rate varied significantly from 11% following repeat operations for recurrent gliomas to 2.5% following non-tumor surgery. Risk of deep wound infection varied more than 11-fold depending on the type of clean neurosurgical operation. It is most feasible to demonstrate the potential efficacy of perioperative antibiotics in clean neurosurgical procedures with the greatest risk of postoperative wound infection. The potential benefit from such prophylaxis would be greatest for patients undergoing these high-risk operations.

Adult↗

PubMed1986

W. W. Keen and the dawn of American neurosurgery.

Before the turn of the century, W. W. Keen was the most celebrated neurosurgeon in the United States. During the Civil War he served as a surgeon in the Union Army. He collaborated with Mitchell and Morehouse in clinical studies that culminated in their publishing Gunshot Wounds and Other Injuries of Nerves. In 1887, he was the first surgeon in the Americas to remove a benign brain tumor. He perfected a technique for ventricular puncture, devised operations for spasmodic torticollis, microcephalus, and tic douloureaux, and introduced many European neurosurgical techniques to the United States. An astute clinician and excellent teacher, Keen had no research interests other than anatomical and pathological dissections. He published over 50 papers on neurosurgical topics, in addition to articles on numerous other subjects. Although recognized as a pioneer in neurosurgery, he is not usually considered a founder of neurosurgery in the United States because of his failure to develop the specialty further than his contemporaries in the remainder of the neurosurgical world. This failure related not to his abilities, but probably to the fact that he was elderly before it became technically possible to perform safe and effective intracranial procedures.

History, 19th Century↗

PubMed1986

BSS Plus: a potential irrigating solution for neurosurgery.

BSS Plus is a pH-stable balanced salt solution similar to glutathione bicarbonate Ringer's solution. Extensively used in ophthalmology, it is of potential value in neurosurgery. In comparative tests of its effectiveness, 28 cats underwent bilateral irrigation of the surface of the cerebral cortex with normal saline on one side and BSS Plus on the other. After 2 hours, a marked decrease was seen in the surface pH of the hemisphere irrigated with normal saline but not of the hemisphere treated with BSS Plus. Blood-brain barrier changes (measured with Evans blue dye techniques) were more evident following saline irrigation. Somatosensory evoked potentials and cerebral blood flow were not significantly altered. Conventional light microscopy using three standard stains did not reveal a significant difference. Transmission electron microscopy studies were performed in 14 animals and scanning electron microscopy in six. In five animals both transmission and scanning electron microscopy studies were conducted after irrigation with both agents without a cottonoid cover and with immediate harvest of superficial layers from the living brain and immersion-fixation in glutaraldehyde. Tissue preservation was superior on the BSS Plus side in all studies. This agent may represent an improved irrigation solution for neurosurgery, but further studies are required.

Animals↗

PubMed1994

John F. Fulton, M.D., and the founding of the Journal of Neurosurgery.

The Journal of Neurosurgery, although the idea of a Chilean neurosurgeon, Alfonso Asenjo, was the product of a well-placed and energetic charter member of the Harvey Cushing Society, John F. Fulton. In the researched files the first formal correspondence is that of Asenjo dated May 20, 1943. When he received Paul Bucy's encouraging reply of June 19, 1943, he promptly betook himself to New Haven, where he spent July 3 and 4 with Fulton. Within a week of that visit, Fulton was writing to the Executive Committee of the Harvey Cushing Society recommending the establishment of such a journal. Fulton contacted his friend and publisher, Charles C. Thomas, and by the end of October he was meeting with representatives of the Banta Publishing Company to discuss matters relating to the printing of the Journal of Neurosurgery, in particular, the scarcity of paper. The twin problems of shortages of paper and financing were soon resolved under the guidance of Thomas, but other details remained. Thus, the first issue, scheduled to appear in January, 1944, was not mailed until the middle of March of that year, but thereafter a regular bimonthly schedule was maintained. While Asenjo should be given proper credit for the idea, this essay confirms the validity of Bucy's listing: "John F. Fulton--Founder (1944)."

History, 20th Century↗

PubMed1994

History of the Journal of Neurosurgery, 1965-1980.

The author, who was editor of the Journal of Neurosurgery from 1975 to 1985, recalls the history of the journal during the 15 hears beginning in 1965, when Dr. Louise Eisenhardt resigned as its first editor. In an addendum, he presents some thoughts on the future of neurosurgery and the role the journal should play in it.

History, 20th Century↗

PubMed1995

The use of magnetic resonance angiography in stereotactic neurosurgery.

The authors discuss the advantages and disadvantages of the use of magnetic resonance (MR) angiography images in stereotactic neurosurgery. Current computer programs designed to assist the neurosurgeon in the planning of stereotactic neurosurgical interventions use intraarterial digital subtraction angiography images to visualize the blood vessels. Magnetic resonance angiography is a recent technique with a number of advantages over the digital subtraction method: it is less invasive and less prone to complications; it provides truly three-dimensional data sets that can be viewed from any direction; and it can visualize both stationary and flowing tissues with the same imaging device and localizer frame. Although digital subtraction images are still superior in contrast and vascular detail, state-of-the-art high-resolution MR angiography sequences provide sufficient vascular detail for planning surgery. Contrast-enhanced MR angiography images were acquired using adapted gradient-echo sequences to compensate for flow-induced distortions; postacquisition distortion correction was not necessary. Five methods to integrate and inspect a possible trajectory in the MR angiography data are discussed. Initial clinical experience with eight patients led to the conclusion that MR angiography is a valuable imaging modality that can be integrated reliably into a stereotactic neurosurgery planning procedure.

Adult↗